Sex and treatment

You might have questions about sex and relationships during treatment. We want you to know that this is normal, and that you can ask your St. Jude team any questions you have. It is also normal to have changes in sexual feelings or activity during treatment, after treatment, or later in life. Having cancer and getting treatment can cause these changes.

It might feel awkward to talk about personal matters at first, but your St. Jude health care team is used to these types of questions. We are here to talk about anything that affects your health and well-being, including sex. This article includes common questions from St. Jude patients, as well as answers from St. Jude team members.

Who can I talk to?

You can talk to someone on your St. Jude team, such as a doctor, nurse, physician assistant, or nurse practitioner. You can talk in private or with someone there for support, such as a parent, friend, child life specialist, psychologist, or social worker.

Will you keep my questions private?

Yes. Your St. Jude team will not share your comments and questions with anyone unless there is a medical concern about your treatment or safety.

What do you mean by “sex and treatment?”

“Sex” in this article means any type of sex you can have. This can include:

Oral sex,

Sex using your hands, fingers, or a sex toy – With or without putting something inside yourself or your partner,

Vaginal sex with penetration (penis or another object in the vagina),

Anal sex with penetration,

Using sex toys, and

Sex by yourself (masturbation).

The body parts that are usually involved in sex have delicate skin. It can bruise, tear, and let infections in more easily than skin in other areas. When you have cancer or get cancer treatment, infections are more likely. They can also be life-threatening. So, understanding how to safely enjoy sex is important. If you use any toys or objects, please clean them carefully before and after using them. Most sex toys have cleaning instructions. Cleaning your toys correctly keeps you and your partner safer and helps the toys last longer.

Keeping your hands and other body parts clean is also important for your health. Practicing good handwashing and personal hygiene helps prevent infections. It can also make close contact more enjoyable for you and your partner. Read Do You Know … Clean Hands to learn more about washing your hands the right way.

What do I need to consider before having sex?

Platelet levels

Platelets are cells in your blood that stick together, or “clot,” to stop bleeding. Having chemo, radiation, or other treatments lowers your platelet counts.

Your platelet count should be at least 50,000 before you have sex with a partner or yourself (masturbation). This is important because most sex has a small risk of causing bruising or bleeding. When your platelet count is normal, you will probably not notice bruising or bleeding. When it is low, your body has a much harder time stopping or controlling bleeding. This can be dangerous, so knowing your platelet count is important.

ANC

ANC stands for “absolute neutrophil count.” A “neutrophil” is a type of white blood cell that protects you from infections. Having chemo, radiation, or other treatments lowers your ANC. Doctors suggest you wait until your ANC is at least 1000 to have sex.

This is important because sex can cause infections, such as yeast infections and urinary tract infections. If your ANC is below 1000, these can be serious. If you have had a stem cell transplant, please talk with your medical team about your ANC level. Women might want to urinate (pee) after having sex with a partner. This can help prevent urinary tract infections.

Avoiding sexually transmitted infections

Sexually transmitted infections, also called STIs, are a risk for anyone who has sex without barrier protection, such as a condom. Even a high ANC does not protect you from getting an STI. When your immune system is weak, an STI is even more dangerous for your health than usual.

If you plan to have sex while receiving treatment, you and your partner should use a form of barrier protection. This lowers your risk of STIs and pregnancy. We recommend latex condoms with nonoxyl-9 spermicide.

Protecting your central line

Cover your central line with a dressing during sex. This helps prevent infection and possible pulling on the line. Your St. Jude team can teach you how to cover the line.

Sex after chemo or radiation

Doctors suggest that you wait at least 72 hours after chemo to have sex, including vaginal, oral, and anal sex. This is the average amount of time it takes chemo to leave your system. Having sex less than 72 hours after chemo could expose your partner to chemo drugs in your body fluids. This can be dangerous, so it is important to talk with your partner about this. Using condoms, even after 72 hours, keeps your partner safer from possible chemo exposure. Ask your St. Jude team about your specific treatment.

There is no set time to wait after external beam radiation. This is radiation you get from a machine outside your body.

Some radiation is placed inside your body. This is called “brachytherapy.” Doctors place small tubes with radioactive material at the tumor site during surgery. This type of radiation lasts 3 to 5 days while you stay in the hospital. You should not have sex until the doctor removes this material. Ask your St. Jude team any other questions about sex and radiation.

Radiation can seriously harm an unborn child. Please read the next question if you have sex while having treatments.

Avoiding accidental pregnancy during chemo or radiation

Being pregnant when you have chemo or radiation has serious risks because:

Chemo and radiation can damage your sperm or eggs. A baby created from those damaged cells could have birth defects.

You might need to stop treatment or change your treatment plan if you get pregnant. This could affect how well your cancer treatment works. Ask your medical team if you have any questions about this.

Doctors suggest waiting until after treatment to get pregnant or get your partner pregnant. Talk with your doctor about the best time. Waiting the right amount of time can help you avoid birth defects and have a child safely. During treatment, we recommend using a reliable form of birth control to lower the risk of pregnancy. We recommend latex condoms with nonoxynol-9 spermicide. Radiation and chemo will not damage this form of birth control.

Will sex feel different while I am getting treatment?

Maybe. You might be tired and nauseated during treatment. You might also feel self-conscious because of physical changes, such as hair loss, skin changes, scars, and weight changes. This can affect the way you feel during sex. These feelings are all normal. Feeling nervous or anxious might make you less interested in sex. This might make it more difficult to have an erection or orgasm.

If you have surgery, ask your doctor when it is safe to have sex again. This helps you avoid pain or slow healing in the area of your surgery. If you have treatment for cancer in the testicles, prostate, pelvis, or certain areas of the brain, the side effects might affect sex. Cancer treatment can also make your vagina feel dry. Using K-Y® Jelly or another lubricant can help.

You will be more comfortable with sex if you wait until you are physically and emotionally ready. Remember, you can feel close and affectionate with your partner in many ways that don’t include sex.

Will my partner get cancer or lose their hair if we have sex during my treatments?

No. You cannot give cancer to another person. But please follow the guidelines above on how long to wait after treatment. After the waiting period, your treatment cannot affect your partner.

I’ve had many blood transfusions. Could I have gotten a disease from them? Could I give it to someone else?

Not likely. The blood for transfusions is kept safe in many ways. The volunteers who give blood must be healthy. They answer many questions before donating, to be sure they do not have risk factors for diseases that spread through blood. A laboratory tests the donor blood for signs of infection, virus, and other diseases before you get it. Ask your doctor if you have more concerns about blood transfusion risks.

Are scans and X-rays safe if I want children or might be pregnant?

Scans and X-rays use low levels of radiation to lower the risk of harming healthy tissues in the body. You might also wear a protective shield during a scan or X-ray. This helps protect your ability to have children later.

A staff member will ask if you could be pregnant if you are female and older than 10. We might also ask you to take a pregnancy test before having scans or X-rays. We do this because scans and X-rays can harm an unborn baby.

Is birth control still important after treatment?

Yes. Always assume you can get pregnant, or get someone pregnant, if you have sex. Treatment affects everyone differently. This includes your eggs or sperm. Yours might be more or less sensitive to chemo and radiation. So, always assume that getting pregnant is possible.

If your doctor said you cannot have children, using condoms with spermicide is still a good idea. They help prevent sexually transmitted infections, also called STIs.

Women who have sex should see a women’s health specialist (gynecologist) regularly. This doctor might stop or change medicine you took to control periods during treatment. If you have not had a menstrual period for 6 months after treatment, please call your gynecologist or talk to your St. Jude medical team.

Even if you don’t have a period, you might get pregnant if you have sex without birth control.

How will I know if I can still have children?

Ask your St. Jude team how your treatment might affect the ability to have children. You can do this before treatment starts. You might be able to store some eggs or sperm before treatment, to have children later. Ask your doctor about the St. Jude Fertility Clinic and your options.

Questions?

If you have questions, please feel free to talk to someone on your medical team at any time. Questions about sex and your specific treatment plan can be confusing, but we are always willing to help.

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This document is not intended to take the place of the care and attention of your personal physician or other professional medical services. Our aim is to promote active participation in your care and treatment by providing information and education. Questions about individual health concerns or specific treatment options should be discussed with your physician.

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